Molecular Mechanisms of Fentanyl-Mediated Sudden Death

Tschirhart, Jared; Li, W.; Guo, Junjing; Zhang, S.

doi:10.1016/j.cjca.2018.07.301

Cited by 3 publications

(1 citation statement)

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“…Opioids also bear a risk of cardiovascular toxicity and cardiac arrest, so that the use of some synthetic opioids is questioned in a setting of chronic coronary artery disease [ 47 ]. Fentanyl particularly has a dose-dependent effect on QT interval prolongation, causes bradyarrhythmia and asystole [ 48 , 49 ] and, particularly in an illicit use and in combination with synergistic cardiotoxic drugs, could be related to sudden death [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong

Neukamm¹,

Halter²,

Auwärter³

et al. 2023

Forensic Toxicol

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Purpose We report a case of a polydrug user who consumed various synthetic cannabinoids and fentanyl from a transdermal patch via a bucket bong. Toxicological results from postmortem matrices with special focus on synthetic cannabinoids are discussed in terms of their relevance to the death. Methods The samples were analyzed by toxicological screening procedures involving immunoassays and gas chromatography–mass spectrometry (GC–MS) as well as quantitative analyses by means of GC–MS and high-performance liquid chromatography–tandem mass spectrometry (LC–MS/MS). Results At the autopsy, coronary artery disease and signs of liver congestion were noted, in the absence of acute myocardial ischemic changes. Femoral blood concentrations of fentanyl and pregabalin were 14 ng/mL and 3,200 ng/mL, respectively. In addition, 2.7 ng/mL 5F-ADB and 13 ng/mL 5F-MDMB-P7AICA were detected together with relatively low amounts of 5 other synthetic cannabinoids in cardiac blood. A total number of up to 17 synthetic cannabinoids were detected in kidney, liver, urine and hair. Fentanyl and 5F-ADB were also detected in the water of the bucket bong. Conclusions The cause of death could be attributed to an acute mixed intoxication by fentanyl and 5F-ADB (both Toxicological Significance Score (TSS) = 3) with a contribution of pregabalin and 5F-MDMB-P7AICA (TSS = 2), in a subject suffering from pre-existing heart damage. The most plausible mechanism of death consists in a respiratory depression. This case report demonstrates that use of opioids in combination with synthetic cannabinoids might be particularly dangerous.

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Section: Discussionmentioning

confidence: 99%

Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong

Neukamm¹,

Halter²,

Auwärter³

et al. 2023

Forensic Toxicol

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Opioids-induced inhibition of HERG ion channels and sudden cardiac death, a systematic review of current literature

Sherbini

Liblik

Lee

et al. 2024

Trends in Cardiovascular Medicine

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A Review of Toxicological Profile of Fentanyl—A 2024 Update

Williamson,

Kermanizadeh

2024

Toxics

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Fentanyl and its analogues are synthetic opioids of varying potencies that are unfortunately heavily abused. Over the last 15 years, fentanyl and its analogues have contributed to the increasing prominence of hospitalisation and numerous deaths due to drug overdose. In this comprehensive literature review, the mechanism of toxicity of the drug in humans is evaluated. A systematic approach was used whereby the relevant literature has been detailed where the toxicity of fentanyl and/or its analogues to different organs/systems were investigated. Furthermore, the review covers the post-mortem toxicological data and demographic information from past fatal cases where fentanyl was believed to be involved. Such insight into fentanyl toxicity is useful as an aid to better understand the toxic doses of the drug and the suspected mechanism of action and the unexpected complications associated with overdose incidences involving the drug. Finally, the review offers an overview of the traditional and emerging test systems used to investigate the adverse effects of fentanyl on human health.

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Molecular Mechanisms of Fentanyl-Mediated Sudden Death

Cited by 3 publications

References 0 publications

Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong

Death after smoking of fentanyl, 5F-ADB, 5F-MDMB-P7AICA and other synthetic cannabinoids with a bucket bong

Opioids-induced inhibition of HERG ion channels and sudden cardiac death, a systematic review of current literature

A Review of Toxicological Profile of Fentanyl—A 2024 Update

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